A forum for people with shoulder pain and rotator cuff injuries.

July 25, 2007

More Thoughts on Shoulder Imaging

So, when you go into your physician with complaints of longstanding
shoulder pain, he may or may not recommend imaging of the shoulder. The
fact of the matter is much of shoulder pain can be diagnosed without any
x-rays. However, there are some times with an initial evaluation that
x-rays are needed.

When we think about this imaging, physicians can simply go through the
following process. Plain x-rays – the old fashioned x-rays –
will give you good information about the bones. Is there any arthritis?
Is there any bone fractures? In deed, in one of the fairly common
problems called calcific tendonitis, one of the tendons becomes calcified and
essentially starts to turn to bone and that can be picked up on x-rays.
Certainly cancer, tumors, all these things, if they involve the bone, can be
picked up on plain x-rays. If the tumors are cancer, or not within the
bone, then they basically escape the attention of plain films.

Magnetic Residence Imaging, or MRI, is technology that’s been
around since the early 80s and it is the best way we have to look at soft
tissues. So that will show any tumors that are not involved in the
bone. They will show more importantly and much, much, much more commonly
abnormalities in the tendon, inflammation in the tendon, rupture of the tendon,
they will reveal bone fractures that are not seen on plain x-rays and that does
happen up to 10% of the time. They essentially give the most information
available cutting without into the shoulder and looking at it.

Ultrasound is a new modality, and it is very useful. You do need
to understand its limitations. Ultrasound will basically tell you how
someone superspinatis tendon is. Now, keep in mind, the superspinatis
tendon is where most of the problems originate with the rotator cuff. And
many times, we will get an ultrasound if we want to find out if its’
worth while to try to treat someone conservatively. Basically, if a
superspinatis tendon is just showing partial tears or inflammation or swelling,
then this person will likely get better without any type of surgery. Even
moderate tears can shown on ultrasound, can very frequently be healed without
surgery; however, if there is a complete tear in the tendon then there is
actually retraction on both sides – so there is basically a separation
between the tear – there’s not a great place for physical therapy
in my opinion. So, the ultrasound is a one trick pony, but it can be
quite practical and can give us a dream life if we really push the non-surgical
rehabilitation aggressively.

Good thought Steve. That can be a great starting point. I am a huge believer in physical therapy for osteoarthritis. I am always surprised by how many patients end up with surgery for arthritis without having gone through a physical therapy regimen. If nothing else it will condition the muscles for a recovery after surgery and for many patients they can avoid surgery altogether.